How Jardiance (Empagliflozin) Helps in Heart Failure with Reduced Ejection Fraction
Jardiance (empagliflozin) significantly reduces the risk of hospitalization for heart failure and cardiovascular death in patients with heart failure with reduced ejection fraction (HFrEF) by 21% compared to placebo, regardless of diabetes status. 1
Mechanism of Action and Benefits
Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, provides several key benefits in HFrEF:
- Reduces cardiovascular mortality and heart failure hospitalizations by 21% (HR 0.79 [95% CI 0.69–0.90]; P < 0.001) 1, 2
- Benefits appear within weeks of initiation and are maintained long-term 1
- Slows decline in kidney function and reduces risk of renal composite outcomes by 38% (HR 0.62 [95% CI 0.43-0.90]) 2
- Improves health-related quality of life in patients with symptomatic chronic heart failure 3
- Works across the entire spectrum of ages, including older patients (≥75 years) 4
Clinical Application in Heart Failure Management
Empagliflozin is recommended as a core component of guideline-directed medical therapy for HFrEF:
- Standard dose: 10 mg once daily 1
- Can be used with eGFR ≥25 mL/min/1.73 m² (do not initiate if lower) 1
- Effective regardless of background heart failure therapies, including:
- ACE inhibitors/ARBs at any dose level
- Beta-blockers at any dose level
- Mineralocorticoid receptor antagonists (MRAs)
- Combination therapies 5
Integration with Other Heart Failure Medications
The 2024 ESC guidelines recommend empagliflozin as part of comprehensive HFrEF therapy:
Foundational quadruple therapy for HFrEF includes:
- ACE inhibitor (or ARNI)
- Beta-blocker
- MRA
- SGLT2 inhibitor (empagliflozin or dapagliflozin) 6
Empagliflozin provides additive benefits when combined with other heart failure medications, regardless of their doses 5
Monitoring and Safety Considerations
Empagliflozin is generally well-tolerated but requires monitoring for:
- Genital mycotic infections (most common adverse effect)
- Urinary tract infections
- Volume depletion/hypotension (particularly in patients on high-dose diuretics)
- Euglycemic diabetic ketoacidosis (rare but serious) 1
Important precautions:
- Hold for at least 3 days before major surgery or procedures requiring prolonged fasting
- Resume when clinically stable and oral intake has been established 1
- Efficacy and safety are consistent regardless of baseline diuretic therapy 7
Clinical Pearl
Unlike many heart failure medications that require careful up-titration, empagliflozin starts at its target dose (10 mg daily) and provides benefits quickly, making it an excellent addition to heart failure therapy with minimal dose adjustments needed.